Immunosuppressive regimens based on Cyclophospamide or Calcineurin inhibitors: Comparison of their effect in the long term outcome of Primary Membranous Nephropathy

Autor: Christos Dioudis, Eirini Grapsa, Smaragdi Marinaki, Dimitrios S. Goumenos, Aimilios Andrikos, Karolos-Pavlos Rapsomanikis, Christos Iatrou, Synodi Zerbala, Athanasios Sioulis, Evangelos Papachristou, Maria Stangou, Ioannis Stefanidis, Ioannis Boletis, Maria Tsilivigkou, Olga Balafa, Nikolaos Kaperonis, Vasiliki Choulitoudi, Ioannis Tzanakis, Sophia Spaia, Apostolos Papadogianakis, Eugene Dafnis, Erasmia Sambani, Fani Papoulidou, Aikaperini Papagianni, Theofanis Apostolou, Dimitrios Vlachakos, Efstathios Mitsopoulos, Panagiota Manolakaki, Paraskevi-Evi Andronikidi, Christos Paliouras, Kyriaki Kolovou, Dorothea Papadopoulou, Stylianos Panagoutsos, Dimitra Galitsiou, Panagiota Papadea, Helen Liakou, Spyridon Golfinopoulos, Kostas Stylianou, George Moustakas
Jazyk: angličtina
Rok vydání: 2019
Předmět:
Male
medicine.medical_treatment
030232 urology & nephrology
Spontaneous remission
030204 cardiovascular system & hematology
Pathology and Laboratory Medicine
Glomerulonephritis
Membranous
Gastroenterology
0302 clinical medicine
Chronic Kidney Disease
Medicine and Health Sciences
Aged
80 and over
Multidisciplinary
Proteinuria
Drugs
Immunosuppression
Middle Aged
Immunosuppressives
3. Good health
Treatment Outcome
Nephrology
Medicine
Female
Anatomy
medicine.symptom
Immunosuppressive Agents
Research Article
medicine.drug
Adult
medicine.medical_specialty
Histology
Adolescent
Cyclophosphamide
Science
Immunology
Calcineurin Inhibitors
Renal function
Immune Suppression
Young Adult
03 medical and health sciences
Signs and Symptoms
Membranous nephropathy
Diagnostic Medicine
Internal medicine
medicine
Humans
Aged
Retrospective Studies
Pharmacology
business.industry
Biology and Life Sciences
Retrospective cohort study
Renal System
medicine.disease
Fibrosis
Calcineurin
Atrophy
business
Developmental Biology
Zdroj: PLoS ONE, Vol 14, Iss 8, p e0217116 (2019)
PLoS ONE
ISSN: 1932-6203
Popis: IntroductionManagement of the Primary Membranous Nephropathy (PMN) usually involves administration of immunosuppressives. Cyclophosphamide (Cyclo) and Calcineurin Inhibitors (CNIs) are both widely used but only limited data exist to compare their efficacy in long term follow-up.AimThe aim of the present study was to estimate and compare long term effects of Cyclo and CNIs in patients with PMN.Patients-methodsClinical data, histologic findings and long term outcome were retrospectively studied. The response to treatment and rate of relapse was compared between patients treated with CNIs or Cyclo based immunosuppressive regimens.ResultsTwenty three centers participated in the study, with 752 PMN patients (Mean age 53.4(14-87) yrs, M/F 467/285), followed for 10.1±5.7 years. All patients were initially treated with Renin Angiotensin Aldosterone System inhibitors (RAASi) for at least 6 months. Based on their response and tolerance to initial treatment, patients were divided into 3 groups, group I with spontaneous remission, who had no further treatment, group II, continued on RAASi only, and group III on RAASi+immunosuppression. Immunosuppressive regimes were mainly based on CNIs or Cyclo. Frequent relapses and failure to treatment were more common between patients who had started on CNIs (n = 381) compared to those initially treated with Cyclo (n = 110), relapse rate: 25.2% vs. 6.4%, pConclusionsLong term follow up showed that administration of Cyclo in PMN is followed by better preservation of renal function, increased response rate and less frequent relapses, compared to CNIs.
Databáze: OpenAIRE
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